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Despite its title this book presents primarily a well thought-out and elaborately argued theoretical treatise, albeit illustrated profusely with
clinical case material. The author attempts to bring order and clarity to the welter of sometimes fuzzily defined, sometimes overlapping concepts that describe the psyche's efforts to cope with traumatic perceptions of unpleasure. To achieve his purpose, Dorpat presents an integrated and comprehensive clinical theory of denial and defense. Among the concepts dealt with are repression, primary repression, denial, disavowal, defense, defensive actions, defense mechanisms, projection, introjection, and projective identification. Like most psychoanalysts, he distinguishes "high-level" defenses, such as repression, from "low-level" or more primitive defenses, such as denial. In contrast to most systematic psychoanalytic discussion of defenses that derive their concepts of defensive systems by studying high-level defenses (e.g., repression) and then extend and generalize "from the top down" to all defensive activity, Dorpat proceeds in the opposite direction, "from the bottom up," in developing his theory of defense. He tries to show how developmentally more advanced defenses are modifications of lower-level defensive actions. He postulates denial as the most basic defense and, using both empirical and logical evidence, he argues persuasively that neither the concepts of primal repression nor those of splitting are as useful as the concept of denial in the construction of his theory of defense. He terms the latter "The Cognitive Arrest Theory of Denial and Repression" and devotes the first chapter (of 16) to an expository overview of his theory. In later chapters he elaborates from a variety of perspectives—developmental, interactional, object relations, conscious and unconscious perception, memory pathology, and brain functions.
Dorpat's exposition of his cognitive theory of denial and defense begins with a microanalyt